Low Serum Potassium Levels Associated with Disease Severity in Children with Nonalcoholic Fatty Liver Disease
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Recent studies have suggested that decreased serum potassium level may contribute to various metabolic disorders in adult patients including nonalcoholic fatty liver disease (NAFLD). We aimed to study the correlation between serum potassium levels and the histologic severity of NAFLD in children. Methods: Pediatric patients with biopsy-proven NAFLD were included in this study. Demographic, clinical, and histo-pathological data were obtained. Multivariable logistic regression analysis was used to assess whether potassium levels are associated with the presence of nonalcoholic steatohepatitis (NASH) or fibrosis after adjusting for possible confounders. A p-value ＜0.05 was considered statistically significant. Results: Among 125 biopsies, 49.6% (62) had evidence of NASH while 66.4% (83) had some degree of fibrosis (stage 1-3). Mean serum potassium was significantly lower in NASH group as compared to non-NASH group (4.4±0.42mmoL/L vs. 4.8±0.21, p＜0.001). Higher potassium level had negative correlation with presence of steatosis, balloon-ing, lobular inflammation, fibrosis and NAFLD activity score (p＜0.05). On multivariable analysis and after adjusting for the metabolic syndrome and insulin resistance, higher potassium level was significantly associated with lower likelihood of having a histological diagnosis of NASH on biopsy (odds ratio [OR], 0.12; 95% confidence interval [95% CI], 0.05-0.28; p＜0.001). Similarly, the likelihood of having fibrosis decreases by 76% for every 0.5 mmoL/L increase in potassium (OR ,0.24; 95% CI, 0.11-0.54; p＜0.001).Conclusion: Our study shows an inverse relationship between serum potassium levels and the presence of ag-gressive disease (NASH and fibrosis) in children with NAFLD.
Abstract
Purpose: Recent studies have suggested that decreased serum potassium level may contribute to various metabolic disorders in adult patients including nonalcoholic fatty liver disease (NAFLD). We aimed to study the correlation between serum potassium levels and the histologic severity of NAFLD in children. Methods: Pediatric patients with biopsy-proven NAFLD were included in this study. Demographic, clinical, and histo-pathological data were obtained. Multivariable logistic regression analysis was used to assess whether potassium levels are associated with the presence of nonalcoholic steatohepatitis (NASH) or fibrosis after adjusting for possible confounders. A p-value ＜0.05 was considered statistically significant. Results: Among 125 biopsies, 49.6% (62) had evidence of NASH while 66.4% (83) had some degree of fibrosis (stage 1-3). Mean serum potassium was significantly lower in NASH group as compared to non-NASH group (4.4±0.42mmoL/L vs. 4.8±0.21, p＜0.001). Higher potassium level had negative correlation with presence of steatosis, balloon-ing, lobular inflammation, fibrosis and NAFLD activity score (p＜0.05). On multivariable analysis and after adjusting for the metabolic syndrome and insulin resistance, higher potassium level was significantly associated with lower likelihood of having a histological diagnosis of NASH on biopsy (odds ratio [OR], 0.12; 95% confidence interval [95% CI], 0.05-0.28; p＜0.001). Similarly, the likelihood of having fibrosis decreases by 76% for every 0.5 mmoL/L increase in potassium (OR ,0.24; 95% CI, 0.11-0.54; p＜0.001).Conclusion: Our study shows an inverse relationship between serum potassium levels and the presence of ag-gressive disease (NASH and fibrosis) in children with NAFLD.
참고문헌 (26)
- Marchesini G, "Nonalcoholic fatty liver disease:a feature of the metabolic syndrome", Diabetes, 50, pp.1844~1850 (2001)
- Schwimmer JB, "Obesity, insulin resistance, and other clinicopathological correlates of pediatric nonalcoholic fatty liver disease", J Pediatr, 143, pp.500~505 (2003)
- Ogden CL, "Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010", JAMA, 307, pp.483~490 (2012)
- Pacifico L, "Pediatric nonalcoholic fatty liver disease, metabolic syndrome and cardiovascular risk", World J Gastroenterol, 17, pp.3082~3091 (2011)
- Tilg H, "Evolution of inflammation in nonalcoholic fatty liver disease: the multiple parallel hits hypothesis", Hepatology, 52, pp.1836~1846 (2010)
- Asrih M, "Inflammation as a potential link between nonalcoholic fatty liver disease and insulin resistance", J Endocrinol, 218, pp.R25~36 (2013)
- Norbiato G, "Effects of potassium supplementation on insulin binding and insulin action in human obesity:protein-modified fast and refeeding", Eur J Clin Invest, 14, pp.414~419 (1984)
- Mariosa LS, "Abdominal obesity is associated with potassium depletion and changes in glucose homeostasis during diuretic therapy", J Clin Hypertens (Greenwich), 10, pp.443~449 (2008)
- Rowe JW, "Effect of experimental potassium deficiency on glucose and insulin metabolism", Metabolism, 29, pp.498~502 (1980)
- Sun K, "Low serum potassium level is associated with nonalcoholic fatty liver disease and its related metabolic disorders", Clin Endocrinol (Oxf), 80, pp.348~355 (2014)
- Alkhouri N, "Lipotoxicity in nonalcoholic fatty liver disease: not all lipids are created equal", Expert Rev Gastroenterol Hepatol, 3, pp.445~451 (2009)
- Azadbakht L, "Beneficial effects of a dietary approaches to stop hypertension eating plan on features of the metabolic syndrome", Diabetes Care, 28, pp.2823~2831 (2005)
- Nobili V, "NAFLD in children: a prospective clinical-pathological study and effect of lifestyle advice", Hepatology, 44, pp.458~465 (2006)
- Manco M, "Waist circumference correlates with liver fibrosis in children with non-alcoholic steatohepatitis", Gut, 57, pp.1283~1287 (2008)
- Cole TJ, "Establishing a standard definition for child overweight and obesity worldwide: international survey", BMJ, 320, pp.1240~1243 (2000)
- Boney CM, "Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus", Pediatrics, 115, pp.e290~296 (2005)
- Fernández JR, "Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents", J Pediatr, 145, pp.439~444 (2004)
- Zahka KG., "Report of the second task force on blood pressure control in children", Md Med J, 36, pp.323~325 (1987)
- Genuth S, "Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Follow-up report on the diagnosis of diabetes mellitus", Diabetes Care, 26, pp.3160~3167 (2003)
- Matthews DR, "Homeostasis model assessment:insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man", Diabetologia, 28, pp.412~419 (1985)
- Matsuda M, "Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp", Diabetes Care, 22, pp.1462~1470 (1999)
- Katz A, "Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans", J Clin Endocrinol Metab, 85, pp.2402~2410 (2000)
- Poynard T, "Variability of the area under the receiver operating characteristic curves in the diagnostic evaluation of liver fibrosis markers:impact of biopsy length and fragmentation", Aliment Pharmacol Ther, 25, pp.733~739 (2007)
- Kleiner DE, "Design and validation of a histological scoring system for nonalcoholic fatty liver disease", Hepatology, 41, pp.1313~1321 (2005)
- Sun K, "Serum potassium level is associated with metabolic syndrome: a population-based study", Clin Nutr, 33, pp.521~527 (2014)
- Ribeiro MC, "Hydrochlorothiazide and high-fat diets reduce plasma magnesium levels and increase hepatic oxidative stress in rats", Magnes Res, 26, pp.32~40 (2013)